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Oxford Handbook of Complementary Medicine

Leading complementary medicine expert Professor Edzard Ernst and his team take a hard look at the evidence behind complementary therapies

This should be a book that every GP will want to use.

We are, after all, expected by our patients to be familiar with complementary medicines even though in reality we often know even less than they do about their use.

In part, this is because the sort of medicine that we practise is based on licensing and on evidence, both of which rarely feature in the world of alternative therapies.

So – is this the book you should buy?

Well, it's an Oxford textbook, so it has some pedigree. It comes plastic-bound and pocket-sized (if you have big pockets).

The paper is thin but of high quality and the print is very small, so this is a book for reference, not for reading. I therefore decided to road test it on a few live patients.

My first encounter was with a man who told me he was taking natural rosehip powder for arthritis. The Oxford handbook was disappointing, as the index has no entry for rosehip (though I later found an entry under ‘osteoarthritis' saying ‘may reduce pain, but more evidence required'.

By contrast, a quick Google search of ‘rosehip arthritis evidence' called up 7,000+ entries.

The first I looked at (arthritiscare.org.uk) led to Dr Thomas Stuttaford in the Times, quoting two clinical trials, while the second (www.nhs.uk) found an excellent appraisal from the NHS Knowledge Service.

My second patient was taking chives and chillies for her blood pressure, but neither the handbook nor Google was of much help here.

My third, a woman with extensive bruising, commented how effective Arnica had been for her – a clear hit for the Oxford Handbook, with more than a page of information and a clear conclusion of ‘no convincing benefit of evidence'.

The individual entries in the handbook are well laid out according to therapies, medicines and conditions.

I was therefore disappointed to find that whereas the entry for Ginkgo suggests that it does not seem to reduce depression or anxiety in menopausal women and is therefore ‘likely to be ineffective or harmful', the entry for menopause suggests that it is likely to be beneficial and that it improves cognitive function in menopausal women. It cannot be both.

Like all printed books, the handbook can rapidly go out of date as new evidence or guidance (such as this year's NICE guideline on the use of glucosamine or chondroitin products in the treatment of osteoarthritis) turns widely regarded impressions upside down.

A handbook is for carrying and this is not a book to carry. Nor is it a book to read from cover to cover. It is limited in its content and not without error, but nonetheless I shall probably keep it and refer to it.

It will sit on the window ledge behind my desk and when a patient talks complementary to me, I shall reach for it and see what Ernst and colleagues have to say, because their quest is evidence-led and when they exist, entries in the handbook are both clear and concise.

For a fuller picture, however, and to understand what my patients are reading, Google will remain a valuable, if risky, option.